title: Early and midterm results of totally endoscopic coronary artery bypass grafting on the beating heart.
abstract: OBJECTIVE
  Despite the early introduction of totally endoscopic coronary artery bypass on the beating heart, only a limited number of cases have been performed. The limiting factor has been the concern about safety and graft patency of the anastomosis. This study describes our experience with totally endoscopic coronary artery bypass on the beating heart with robotic assistance and its early and midterm results.
  
  
  METHODS
  In 365 cases of robotic cardiac operations, 162 patients underwent robotic coronary artery bypass grafting on the beating heart, of whom 60 patients (46 male, 14 female) underwent totally endoscopic coronary artery bypass on the beating heart. The patients' mean age was 56.97 ± 9.7 years (33-77 years). Left internal thoracic artery to left anterior descending anastomosis was performed using the U-Clip device.
  
  
  RESULTS
  We completed 58 totally endoscopic coronary artery bypass procedures, in which 16 patients received hybrid procedures. Two patients had conversions to a minithoracotomy. The average left internal thoracic artery harvesting and anastomosis times were 31.3 ± 10.5 (18∼55) minutes and 11.3 ± 4.7 (5∼21) minutes, respectively. The mean operating room and operation times were 336.1 ± 58.5 (210∼580) minutes and 264.8 ± 65.6 (150∼420) minutes, respectively. The drainage was 164.9 ± 83.2 (70∼450) mL. Before discharge, 50 patients underwent angiography and 8 patients underwent computed tomography angiography, and the study showed that graft patency was 100%. Unexpectedly, the left internal thoracic artery graft developed a collateral branch in 2 patients. After discharge, all patients were followed up by computed tomography angiography. The average follow-up time was 12.67 ± 9.43 (1-40) months. One patient had gastric bleeding after surgery.
  
  
  CONCLUSIONS
  Totally endoscopic coronary artery bypass on the beating heart is a safe procedure in selected patients and produces excellent early and midterm patency of anastomosis.
authors.affiliation: Minimally Invasive and Robotic Cardiac Surgery Center, Department of Cardiovascular Surgery, PLA General Hospital, Institute of Cardiac Surgery, Beijing, China. gaochq301@yahoo.com
authors.forename: Changqing
authors.initials: C
authors.lastname: Gao
authors.forename: Ming
authors.initials: M
authors.lastname: Yang
authors.forename: Yang
authors.initials: Y
authors.lastname: Wu
authors.forename: Gang
authors.initials: G
authors.lastname: Wang
authors.forename: Cangsong
authors.initials: C
authors.lastname: Xiao
authors.forename: Yue
authors.initials: Y
authors.lastname: Zhao
authors.forename: Jiali
authors.initials: J
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D002681:China; D017023:Coronary Angiography / Q000379:methods; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012371:Robotics; D025321:Surgery, Computer-Assisted; D013908:Thoracotomy; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014654:Vascular Patency